Intro to Counterstrain Flashcards
What is counterstrain?
dysfunction which inhibited by apply a position of mild strain in direction exactly opposite to that of the false strain effect
use specific point of tenderness related to this dysfunction followed by specific directed positioning to achieve the desire
Posterior Tender points
PT3-5
PT6-UPL5
What invented counterstrain?
Lawrence Jones DO
1955
discovered posterior tender points
Trigger point vs Tender point
Trigger point
- pt present with characteristic pain pattern
- located in muscle tissue
- locally tender
- elicits jump sign and radiating pain pattern
- taut band of tissue
- twitch response with snapping palpation
- demographia of skin over point
Tender point
- no pain pattern
- located in muscles, tendons, ligaments, fascia,
- locally tender
- jump sign but NO radiating patterin
- taut band not present
- twitch response not present
- demographia
Treatment for trigger point and tender point
Trigger point
- spray and stretch
- trigger point injection
Tender point
- spontaneous release by positioning (counterstrain)
Trauma Physiology
trauma
1) changes in myofascial tissue at microscopic and biochemical leve
2) damage to myofibrils and microcirculation
Nociceptive information to CNS
Counterstrain Theories
1) Nociceptive model
2) proprioceptive model
3) four phases of counterstrain
Nociceptive Model
- mechanism of action
- example (ankle sprain)
a tissue is strained recruiting nociceptors within that tissue (muscle, tendon, ligament)
Reflexive contraction of affected tissues
contraction of affected tissue become neutral
Ankle
- reflexive contraction occurs at lateral ankle
- contraction of the lateral ankle becomes the new neutral
Proprioception Model
- mechanism of action
- example- whip lash
maintain tone for a period after the stimulus has ended
Muscle spindle fiber
- excessively rapid stretch of primary spindle cell can induce a protective contraction in extrafusal fibers related to it, which can maintain tone for a period after the stimulus has ended
Muscle is strained (agonist)-> antagonist muscle is shortened ( turns down spindling fire rate) => CNS turns up gain for antagonist gamma system
-> antagonist contraction become “neutral”
Whiplash
- posterior cervical muscles are strained
- anterior cervical muscles shorteneed CNS turns up gain for antagonist gamma system
- antagonist contraction becomes the new neutral
Counterstrain Theory: Nociceptor
- nociceptor recruitment
- agonist (affected tissue) shortened
- agonist tissue shortening
Counterstrain Theory:
proprioceptor
antagonist muscle shortened
antagonist muscle shortening becomes new neutral
gamma loop becomes new neutral
nociceptor vs proprioceptor models
local constriction of muscles causes decreased circulation, causing localized edema and back up products of metabolism
Phases of counterstrain
1) relaxation
2) reset of spindle fibers and nociceptors
3) washout
4) slow return to neutral
Phase of Counterstrain: relaxation
shortened the affected tissue in 3 planes
- flexion/extension
- sidebending
- rotation
- sometimes traction or compression
rapid reduction in noiceptive input
Phase of Counterstrain: spindle reset
primary endings of muscle spindle stretch receptors (annulospiral)
- length
- rate of change in length of muscle (dynamic)
secondary endings of muscle spindle stretch receptors ( flower spray)
- length
- not dynamic changes (static)
Phase of Counterstrain: Washout
increased muscular tone inhibits blood flow which causes buildup of waste products
metabolic washout begins at 10-15 seconds after optimal position achieved
peak washout- 1 minute
Phase of Counterstrain: slow return to neutral
rapid return could reactivate spindle cell activity
muscle spindles remain somewhat facilitated for up to 24 hours after treatment
- remind patients to take it easy for next day after treatment
Counterstrain Treatment steps (7)
- Find significant tenderpoint
- establish a tenderness scale
- monitor tender point throughout treatment
- place patient in a position of optimal comfort
- Maintain position for 90 seconds (120 sec for ribs_
- slowly return to neutral
- recheck tender point
- Find significant tenderpoint
myofascial structure (ligament, tendon, fascia)
myotomal, dermatomal and scleotomal relationship
scan region of body associated with complaints
people tend to bend around a tend point
- Establish a tenderness scale
scale from 1-10
money and change
visual analog scale
- Maintain contact throughout treatment
palpate changes that occur during treatment
allow for fine-tuning throughout treatment
allow physician and patient to acknowledge treatment success
- position of optimal comfort
start with position considered to be close to optimal ( from text or manual)
- midline position: treatment positions tend to be primarily flexion or extension
- distant from midline positions:
treatment position tend to be primarily sidebending/rotational
Fine tune with small arcs of movement
- Maintain position for 90 seconds
• 10-15 seconds to begin wash out • 1 minute for full wash out • Dr. Jones found that holding for shorter periods resulted in greater return of dysfunction • Longer periods resulted in no significant improvement of points - ribs are held for 120 seconds
- Retest tender point
• Troubleshooting — Did you return to neutral slowly? — Did your patient try to 'help"? — Is the tender point really a trigger point? — Is there another/worse tender poi that needs to be treated first?
Important considerations for counterstrain
communication
light contact with tender point throughout treatment
90 sec is long time
SLOWLY return to neutral
no more than 6 tender points per treatment
Therapeutic pulse
intensity approximates radial pulse
position of comfort
position at which at least 70% of tenderness is allleviated
position of optimal comfort
position at which 100% tenderness is alleviated
therapeutic reaction
situation which occurs in 20-30% of patients treated with counterstrain
maverick
tender point that does not respond to typical positioning
usually requires opposite position from standard
absolute contraindications for counterstrain
- trauma
- severe illness which strict positional restrictions preclude treatment
- instability of treatment area (neuro and vascular side effects)
- vascular and neurological syndrome
- severe degenerative spondolysis
Relative contraindications for counterstrain
- patient cannot voluntarily relax
- patient who cannot discern level of pain or its secondary to position
- patient who cannot understand the instructions
- patients with underlying conditions ( arthiritis, CT disease)
Counterstrain benefits
- passive, indirect technique
- can be used in pts with severe osteoporosis, metastatic bone disease and acute injuries
- absolute requirement is that patient must be able to willing to relax
